Rates of women who are opting for preventive mastectomies, such as Angeline Jolie, have increased by an estimated 50 percent in recent years, experts say. But many doctors are puzzled because the operation doesn't carry a 100 percent guarantee, it's major surgery -- and women have other options, from a once-a-day pill to careful monitoring.

About 1 percent of people have rheumatoid arthritis, a crippling disease in which the immune system goes awry and attacks the joints.

For nearly two decades, the standard drug against the disease has been methotrexate, originally developed to fight cancer. But two out of three patients don’t respond well to it.

Enbrel targets inflammation-causing proteinThe newer drug, Enbrel, belongs to a class of medicines that target an inflammation-causing protein called tumor necrosis factor, or TNF. Such drugs have helped people who have not benefited from methotrexate.

The new study, outlined this week in The Lancet medical journal, investigated for the first time whether giving both drugs from the onset would be better than using one alone. Conducted by experts at the Karolinska Institute in Stockholm, Sweden, it involved 682 patients who were given either one of the two drugs or both.

A year after treatment began, 35 percent of the patients in the combination group were in remission, compared with 13 percent of those on methotrexate alone and 16 percent of those on Enbrel alone.

There was no further deterioration of joints in 80 percent of patients on combination treatment, compared with 68 percent on methotrexate and 57 percent on Enbrel alone.

Dr. Armin Schnabel of the Rheumatology and Immunology Clinic in Bad Wildbad, Germany, said that although the results show the combination treatment is better, therapy for rheumatoid arthritis remains imperfect.

“Efficacy can be enhanced by combining (Enbrel) and methotrexate from the beginning, but even the combination leaves a sizable number of patients with active inflammation,” said Schnabel, who was not connected with the research.

The Lancet study involved people who had suffered from the disease for a long time. Perhaps aggressive combination treatment early in the course of the disease could make a big difference in switching off the destruction caused by inflammation, he said.